Healthcare Provider Details

I. General information

NPI: 1316922644
Provider Name (Legal Business Name): THOMAS JOSEPH O'BRIEN PSY D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/09/2005
Last Update Date: 01/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 VINE ST
HARTFORD CT
06112-1639
US

IV. Provider business mailing address

114 COLEMAN RD
WETHERSFIELD CT
06109-3327
US

V. Phone/Fax

Practice location:
  • Phone: 860-297-0852
  • Fax:
Mailing address:
  • Phone: 860-436-9060
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number002550
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: